The owner of a medical consulting company was sentenced to two years in federal prison for defrauding health insurers. Steven Berglund, the 52-year-old owner of Elite Healthcare, pleaded guilty to conspiracy to commit wire fraud and healthcare fraud on Nov. 10, 2021 — three days into his criminal trial. He later attempted to withdraw his plea, arguing that the stress of the trial had left him with diminished mental capacity. The court rejected his attempts, ruling that Mr. Berglund had understood his plea and entered it knowingly and voluntarily.
At his trial, the government had introduced evidence showing that Mr. Berglund had organized and led an elaborate “pass-through billing” scheme in which health insurers were deceived into paying Palo Pinto General Hospital for laboratory tests were actually performed by out-of-network laboratories. (Due to its status as a rural hospital, Palo Pinto was often able to receive higher reimbursements than urban hospitals or out-of-network labs.)
The evidence also showed that Mr. Berglund and his coconspirators used an overseas company to conduct the fraudulent billing, and used front companies to pay kickbacks to induce doctors to order more laboratory tests. According to court documents, Mr. Berglund and other members of the conspiracy submitted more than $54 million in laboratory services claims; as a result, insurers paid Palo Pinto more than $8 million. After paying the out-of-network labs, the billing company involved in the scheme, and kickbacks, the coconspirators divvied up rest of the proceeds. Four of Mr. Berglund’s coconspirators were previously sentenced. The court ordered all five defendants jointly and severally liable for $2.4 million in restitution.
